微创治疗高血压脑出血患者脑水肿及AQP4疗效的Meta分析

A Meta-analysis of the Efficacy of Minimally Invasive Treatment of Cerebral Edema and AQP4 in Patients with Hypertensive Cerebral Hemorrhage

目的评价微创治疗高血压脑出血患者脑水肿及水通道蛋白4(Aquaporin 4,AQP4)疗效。方法检索万方医学、CBM中国生物医学、知网医学、Cochrane Library、PubMed、Embase,检索自建库至2022年10月,微创治疗高血压脑出血患者脑水肿及AQP4疗效的临床随机对照试验。3名研究者独立筛选收集、提取、评估相关数据。应用Review Manager 5.3软件进行Meta分析。结果本研究共纳入11个临床随机对照试验,1064例患者。结果显示在AQP4的变化方面,微创穿刺引流术与常规开颅手术治疗、小骨窗手术治疗及内科保守治疗比降低更明显,差异有统计学意义[SMD=-8.40,95%CI(-12.36,-4.44),P<0.01;SMD=-2.87,95%CI(-5.33,-0.41),P<0.05;SMD=-2.58,95%CI(-4.32,-0.83),P<0.01];在脑水肿体积变化方面,微创穿刺引流术优于常规开颅手术治疗及内科保守治疗,差异有统计学意义[SMD=-1.22,95%CI(-2.14,-0.29),P<0.05;SMD=-2.72,95%CI(-4.63,-0.81),P<0.01]。微创穿刺引流术较常规开颅手术治疗比能更好地降低Cys-C的水平,差异有统计学意义[SMD=-2.76,95%CI(-4.87,-0.66),P<0.05];微创穿刺引流术较内科保守治疗比能更好地降低TLR4的水平,差异有统计学意义[SMD=-0.72,95%CI(-0.98,-0.46),P<0.01]。结论高血压性脑出血患者采取微创穿刺引流术治疗能更好地减轻脑水肿体积,降低AQP4、Cys-C及TLR4水平,减轻脑出血间接损伤。

Objective To evaluate the efficacy of minimally invasive treatment of cerebral edema and Aquaporin 4(AQP4)in patients with hypertensive cerebral hemorrhage.Methods Clinical randomized controlled trials on the efficacy of minimally invasive treatment of cerebral edema and AQP4 in patients with hypertensive cerebral hemorrhage were searched in Wanfang Medicine,CBM China Biomedicine,CNKI Medicine,Cochrane Library,PubMed,and Embase,since their establishment to October 2022.Three investigators were independently screened to collect,extract,and evaluate relevant data.Meta-analysis was performed using Review Manager 5.3 software.Results A total of 11 clinical randomized controlled trials with 1064 patients were included in this study.The results showed that in terms of changes in AQP4,minimally invasive puncture and drainage decreased more significantly than conventional craniotomy treatment,small bone window surgical treatment and conservative medical treatment,and the differences were statistically significant[SMD=-8.40,95%CI(-12.36,-4.44),P<0.01;SMD=-2.87,95%CI(-5.33,-0.41),P<0.05;SMD=-2.58,95%CI(-4.32,-0.83),P<0.01].In terms of cerebral edema volume change,minimally invasive puncture and drainage was superior to conventional craniotomy treatment and conservative medical treatment,and the differ-ence was statistically significant[SMD=-1.22,95%CI(-2.14,-0.29),P<0.05;SMD=-2.72,95%CI(-4.63,-0.81),P<0.01].Minimally invasive puncture and drainage reduced Cys-C levels better than conventional open surgical treat-ment,and the difference was statistically significant[SMD=-2.76,95%CI(-4.87,-0.66),P<0.05].Minimally invasive puncture and drainage was better than conservative medical treatment in reducing TLR4 levels,and the difference was statistically significant[SMD=-0.72,95%CI(-0.98,-0.46),P<0.01].Conclusion Minimally invasive puncture and drainage treatment in patients with hypertensive cerebral hemorrhage can better reduce the volume of cerebral edema,lower AQP4,Cys-C and TLR4 levels,and reduce indirect damage of cerebral hemorrhage.